Surgical mystery

Where is the missing pituitary rongeur tip?

Ali Bydon, Risheng Xu, John V. Conte, Ziya L. Gokaslan, Jeffrey A. Brinker, Timothy F. Witham, Reza Yassari

Research output: Contribution to journalArticle

Abstract

Study Design.: Case report. Objective.: We report the unusual case of a patient who was referred to our institution after she sustained an intraoperative injury to the common iliac vein during posterior lumbar discectomy at L5-S1 with a pituitary rongeur. There was only minimal bleeding with spontaneous hemostasis and no hemodynamic instability. Subsequently, the referring surgeon noted that the pituitary rongeur tip was missing. Sumary of Background Data.: Vascular injury during lumbar discectomy is a rare, but potentially devastating complication. Rapid diagnosis and treatment is traditionally targeted toward hemodynamic stabilization and repair of compromised structures. METHODS.: Intraoperative fluoroscopy confirmed the presence of the tip anterior to the L3 vertebral body, indicating a possible intravascular migration of the foreign body. After completion of the surgical procedure, an abdominal computed tomography scan failed to confirm the metallic object within the abdominal cavity. Subsequent imaging studies demonstrated the presence of the rongeur tip in the left ventricle. Transthoracic echocardiogram and cardiac catheterization confirmed the presence of a patent foramen ovale and localized the rongeur tip within the papillary cords of the left ventricle, in close proximity of the mitral valve leaflets. RESULTS.: After failure to retrieve the foreign object during cardiac catheterization, the patient underwent sternotomy, removal of foreign metallic object, and closure of patent foramen ovale. Conclusion.: Close multidisciplinary collaboration allowed for proper diagnosis and the safe retrieval of the missing rongeur tip from the left ventricle.

Original languageEnglish (US)
JournalSpine
Volume35
Issue number17
DOIs
StatePublished - Aug 1 2010
Externally publishedYes

Fingerprint

Heart Ventricles
Patent Foramen Ovale
Diskectomy
Cardiac Catheterization
Foreign Bodies
Foreign-Body Migration
Hemodynamics
Iliac Vein
Sternotomy
Abdominal Cavity
Vascular System Injuries
Fluoroscopy
Hemostasis
Mitral Valve
Tomography
Hemorrhage
Wounds and Injuries
Therapeutics
Surgeons

Keywords

  • discectomy
  • embolization
  • fusion
  • lumbar
  • posterior
  • rongeur
  • vascular injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Bydon, A., Xu, R., Conte, J. V., Gokaslan, Z. L., Brinker, J. A., Witham, T. F., & Yassari, R. (2010). Surgical mystery: Where is the missing pituitary rongeur tip? Spine, 35(17). https://doi.org/10.1097/BRS.0b013e3181d85bec

Surgical mystery : Where is the missing pituitary rongeur tip? / Bydon, Ali; Xu, Risheng; Conte, John V.; Gokaslan, Ziya L.; Brinker, Jeffrey A.; Witham, Timothy F.; Yassari, Reza.

In: Spine, Vol. 35, No. 17, 01.08.2010.

Research output: Contribution to journalArticle

Bydon, A, Xu, R, Conte, JV, Gokaslan, ZL, Brinker, JA, Witham, TF & Yassari, R 2010, 'Surgical mystery: Where is the missing pituitary rongeur tip?', Spine, vol. 35, no. 17. https://doi.org/10.1097/BRS.0b013e3181d85bec
Bydon A, Xu R, Conte JV, Gokaslan ZL, Brinker JA, Witham TF et al. Surgical mystery: Where is the missing pituitary rongeur tip? Spine. 2010 Aug 1;35(17). https://doi.org/10.1097/BRS.0b013e3181d85bec
Bydon, Ali ; Xu, Risheng ; Conte, John V. ; Gokaslan, Ziya L. ; Brinker, Jeffrey A. ; Witham, Timothy F. ; Yassari, Reza. / Surgical mystery : Where is the missing pituitary rongeur tip?. In: Spine. 2010 ; Vol. 35, No. 17.
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